Search Results (918)

Objectives: Pulmonary embolism (PE) is an uncommon but potentially fatal complication of acute ischaemic stroke (AIS). Its global burden and prevention remain incompletely defined. We performed a systematic review and meta-analysis (PEARL-AIS) to estimate prevalence, risk factors, outcomes, and prophylactic efficacy, with GRADE evidence appraisal. Methods: Following PRISMA 2020 and MOOSE guidelines, five databases (PubMed, Embase, Cochrane, Scopus, Web of Science) were searched (1995–2024). The protocol was prospectively registered (OSF s25ny). Random-effects models (DerSimonian–Laird; REML sensitivity) were used to pool prevalence and odds ratios; heterogeneity was evaluated with I², Cochran’s Q, and τ². Influence (leave-one-out) and subgroup analyses for prevalence and mortality of PE in AIS were explored. Bias was assessed using the Modified Jadad Scale; overall certainty was graded with the GRADE framework. Results: Twenty-four studies met the inclusion criteria (n = 25,666,067), of which seventeen studies (n = 23,637,708) contributed to pooled prevalence analyses. The pooled prevalence of PE after AIS was 0.40% (95% CI 0.33–0.49), approximately six-fold higher than in the general population, with considerable heterogeneity (I² > 90%, Cochrane classification). The pooled mortality among AIS patients with PE was 12.9% (95% CI 1.6–31.7). Mortality risk was significantly higher in AIS patients with PE (OR 4.96, 95% CI 2.98–8.24). Atrial fibrillation (29%), cancer (19%), and smoking (23%) were common; hypertension (54%) and diabetes (23%) were prevalent but not predictive, with diabetes showing a paradoxical protective association (OR 0.88, 95% CI 0.84–0.92). Pharmacological prophylaxis was associated with a reduced risk of PE (OR 0.64, 95% CI 0.46–0.90; I² = 0%), supported by moderate-certainty evidence. Conclusions: PE is an uncommon but often fatal complication of AIS. Traditional venous thromboembolism predictors underperform in this context, suggesting a stroke-specific thromboinflammatory mechanism linking the brain and lung axis. Despite considerable heterogeneity and low-to-moderate certainty of evidence, pharmacological prophylaxis demonstrates a consistent protective effect. Systematic PE surveillance and tailored prophylactic strategies should be integral to contemporary stroke care, while future studies should refine risk stratification and elucidate the mechanistic underpinnings of this brain–lung thromboinflammatory continuum. Full article

Air pollutants pose a growing public health concern in Puerto Rico (PR), particularly from rapid industrialization, military activities, environmental changes and natural disasters. A total of 193 pollutants, comprising the 187 hazardous air pollutants and the 6 criteria air pollutants—including particulate matter (PM), carbon monoxide (CO), volatile organic compounds (VOC), and heavy metals—coincide with rising respiratory disease rates (e.g., lung cancer) documented in national and regional health registries. This study aimed to review major air pollutants in PR, their molecular carcinogenic mechanisms (mostly focused on respiratory-related cancers), and the geographic areas impacted significantly. We conducted an extensive literature search utilizing peer-reviewed scientific articles (PubMed and Web of Science), governmental reports (EPA, WHO, State of Global Air), public health registries, (Puerto Rico Central Cancer Registry and International Agency for Research on Cancer) and local reports. Data on pollutant type, source, molecular pathways, and carcinogenic properties were extracted and synthesized. Our analysis identified ethylene oxide (EtO), polycyclic aromatic hydrocarbons, and PM from industrial sites as key pollutants. The municipalities of Salinas and Vieques, hubs of industrial activity and military exercises, respectively, emerged as critical hotspots where high concentrations of monitored pollutants (e.g., EtO, formaldehyde, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and diesel PM) are associated with a significant prevalence of cancer and respiratory diseases. These agents, known to induce genomic instability and chromosomal aberrations, were correlated with elevated local cancer incidence. Our findings underscore the urgent need for targeted public health interventions and support a multi-pronged strategy that includes: (1) enhanced regulatory oversight of EtO and other hazardous air pollutant emissions; (2) community-based biomonitoring of high-risk populations; and (3) investment in public health infrastructure and a transition to cleaner energy sources. Integrating rigorous environmental science with public health advocacy is essential to strengthen PR’s cancer-control continuum and foster resilience in its most vulnerable communities. Full article

This study examines the design and implementation of a sensor developed to measure total pressure in supersonic flow conditions using nitrogen as the working fluid. Using a combination of absolute and differential pressure sensors, the total pressure distribution downstream of a nozzle—where normal shock waves are generated—was characterized across a range of low-pressure regimes. The experimental results were employed to validate and calibrate computational fluid dynamics (CFD) models, particularly within pressure ranges approaching the limits of continuum mechanics. The validated analyses enabled a more detailed examination of shock-wave behavior under near-continuum conditions, with direct relevance to the operational environment of differentially pumped chambers in Environmental Scanning Electron Microscopy (ESEM). Furthermore, an entropy increase across the normal shock wave at low pressures was quantified, attributed to the extended molecular mean free path and local deviations from thermodynamic equilibrium. Full article

Purpose: Despite significant attention being paid to compression garments (CG) in the sports field, there remains ongoing debate regarding their actual effectiveness in enhancing athletic performance and expediting post-exercise recovery. This article examines their various aspects, with a focus on CG design and the materials they are made of, aiming to analyze the importance of personalized compression strategies based on individual anthropometric measurements and non-linear compression designs. Methods: Using anthropometric analysis of 40 healthy participants, this study examines the morphological characteristics of the lower limb and their implications for CG design. Results: Measurements of limb length and circumferences revealed complex interactions among anatomical variables, emphasizing the need for customized and adaptable device design. Finite element simulations clarified the challenges in achieving uniform pressure gradients along the lower limb, highlighting the limitations of one-piece devices and suggesting tailored segmented designs for individual limb segments. Conclusion: The results demonstrate that one-piece devices often fail to provide optimal compression due to non-linear variations in limb dimensions. Conversely, segmented devices, particularly those with bilinear progression, exhibited superior performance in applying targeted compression across different limb segments. This more detailed approach to customization could significantly contribute to optimizing outcomes and user comfort. Full article

Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke, disproportionately affecting older adults and is associated with high rates of mortality, functional dependence, and long-term cognitive decline. Aging profoundly alters the structure and function of the cerebral vasculature, predisposing the brain to both covert hemorrhage and the development of cerebral microbleeds (CMBs), small, often subclinical lesions that share common pathophysiological mechanisms with ICH. These mechanisms include endothelial dysfunction, impaired cerebral autoregulation, blood–brain barrier breakdown, vascular senescence, and chronic inflammation. Systemic factors such as age-related insulin-like growth factor 1 (IGF-1) deficiency further exacerbate microvascular vulnerability. CMBs and ICH represent distinct yet interconnected manifestations along a continuum of hemorrhagic small vessel disease, with growing recognition of their contribution to vascular cognitive impairment and dementia (VCID). Despite their increasing burden, older adults remain underrepresented in clinical trials, and few therapeutic approaches specifically target aging-related mechanisms. This review synthesizes current knowledge on the cellular, molecular, and systemic drivers of ICH and CMBs in aging, highlights diagnostic and therapeutic challenges, and outlines opportunities for age-sensitive prevention and individualized care strategies. Full article

We here delve into the intricate and evolving concepts of brain death and consciousness, particularly at the end of life. We examine the historical and technological advancements that have influenced our understanding of death, such as mechanical ventilation and resuscitation techniques. These developments have challenged traditional definitions of death, leading to the concept of brain death, defined as the irreversible loss of all brain functions, including the brainstem. We emphasize that consciousness exists on a continuum, ranging from full alertness to deep coma and complete cessation of brain activity. It explores various disorders of consciousness, including coma, vegetative state, minimally conscious state, and locked-in syndrome, each with distinct characteristics and levels of awareness. Neuroimaging techniques, such as EEG, fMRI, and DTI, are highlighted for their crucial role in diagnosing and understanding disorders of consciousness. These techniques help to detect covert consciousness, assess brain activity, and predict recovery potential. The phenomenon of the “wave of death,” which includes a paradoxical surge in brain activity at the point of death, is also discussed. We address the challenges in defining and understanding both death and consciousness, calling for biologically grounded, ethically defensible, and culturally sensitive definitions. We advocate for standardized neuroimaging protocols, longitudinal studies, and the integration of artificial intelligence to improve diagnosis and treatment. In conclusion, the document underscores the importance of an integrated, evidence-based approach to understanding the gray zones between life and death, recognizing that consciousness and death are dynamic processes with both biological and experiential dimensions. Full article

Nano- and micro-indentation have become essential tools for quantifying the micromechanical behavior of rocks beyond traditional macroscopic tests. This review summarizes the historical evolution, experimental methodologies, and interpretation models (e.g., Oliver–Pharr, Doerner–Nix, energy-based methods, Hertz/ECM/Lawn), with a particular focus on rock-specific challenges such as heterogeneity, anisotropy, and surface roughness. A structured literature survey (1980–August 2025) covers representative studies on shale, limestone, marble, sandstone, claystone, and granite. The transition from classical hardness measurements to advanced instrumented indentation has enabled more reliable determination of localized properties, including hardness, elastic modulus, fracture toughness, and creep. Special attention is given to the applicability and limitations of different interpretation models when applied to heterogeneous and anisotropic rocks. Current challenges include high sensitivity to surface conditions and difficulties in capturing the full complexity of natural rock behavior. Looking forward, promising directions involve intelligent systems that integrate AI-driven data analytics, robotic automation, and multiscale modeling (from molecular dynamics to continuum FEM) to enable predictive material design. This review aims to provide geoscientists and engineers with a comprehensive foundation for the effective application and further development of indentation-based testing in rock mechanics and geotechnical engineering. Full article

Cave systems serve as key interfaces connecting surface and underground carbon cycles, and research on their carbon dynamics provides a unique perspective for revealing the mechanisms of carbon transport and transformation in karst critical zones. In this study, we established a multi-factor monitoring framework spanning the atmosphere–soil–cave continuum and associated meteorological conditions, continuously recorded cave microclimate parameters (temperature, relative humidity, atmospheric pressure, and cave winds) and CO₂ concentrations across atmospheric–soil–cave interfaces, and employed stable carbon isotope (δ¹³C) tracing in Mahuang Cave, a typical karst cave in southwestern China, from 2019 to 2023. The results show that the seasonal amplitude of atmospheric CO₂ and its δ¹³C is small, while soil–cave CO₂ and δ¹³C fluctuate synchronously, exhibiting “high concentration-light isotope” signatures during the rainy season and the opposite pattern during the dry season. Cave CO₂ concentrations drop by about 29.8% every November. Soil CO₂ production rates are jointly controlled by soil temperature and volumetric water content, showing a threshold effect. The δ¹³C response exhibits nonlinear behavior due to the combined effects of land-use type, vegetation cover, and soil texture. Quantitative analysis establishes atmospheric CO₂ as the dominant source in cave systems (66%), significantly exceeding soil-derived contributions (34%). At diurnal, seasonal, and annual scales, carbon-source composition, temperature and precipitation patterns, ventilation effects, and cave structure interact to control the rhythmic dynamics and spatial gradients of cave microclimate, CO₂ levels, and δ¹³C signals. Our findings enhance the understanding of carbon transfer processes across the karst critical zone. Full article

Right heart failure (RHF) remains an under-recognized yet devastating condition in critically ill and chronic patients, frequently complicating cardiac surgery, pulmonary embolism, advanced heart failure, sepsis and left ventricular assist device (LVAD) implantation. Despite growing awareness, clinical decision making is still hampered by the complex pathophysiology, limitations in diagnosis and a fragmented therapeutic landscape. In recent years, progress in hemodynamic phenotyping, advanced echocardiographic and biomarker-based assessment, and the development of mechanical circulatory support (MCS) systems, including percutaneous and surgical right ventricle assist devices (RVAD), veno-arterial extracorporeal membrane oxygenation (V-A ECMO), Impella RP (right percutaneous) or BiPella (Impella CP/5.0/5.5 + Impella RP) has expanded the armamentarium for managing RHF. This review synthetizes current evidences on the anatomical, physiological and molecular underpinnings of RHF, delineates the distinction and continuum between acute and chronic forms and provides a comparative analysis of diagnostic tools and MCS strategies. By integrating mechanistic insights with emerging clinical frameworks, the review aims to support earlier recognition, tailored management and innovative therapeutic approaches for this high-risk population. Full article

The pharmacological quality of Astragalus membranaceus var. mongholicus (AMM) is determined by its bioactive compounds, and developing a rapid prediction method is essential for quality assessment. This study proposes a predictive model for AMM bioactive compounds using hyperspectral imaging (HSI) and wavelet domain multivariate features. The model employs techniques such as the first-order derivative (FD) algorithm and the continuum removal (CR) algorithm for initial feature extraction. Unlike existing models that primarily focus on a single-feature extraction algorithm, the proposed tree-structured feature extraction module based on discrete wavelet transform and one-dimensional convolutional neural network (1D-CNN) integrates FD and CR, enabling robust multivariate feature extraction. Subsequently, the multivariate feature cross-fusion module is introduced to implement multivariate feature interaction, facilitating mutual enhancement between high- and low-frequency features through hierarchical recombination. Additionally, a multi-objective prediction mechanism is proposed to simultaneously predict the contents of flavonoids, saponins, and polysaccharides in AMM, effectively leveraging the enhanced, recombined spectral features. During testing, the model achieved excellent predictive performance with R² values of 0.981 for flavonoids, 0.992 for saponins, and 0.992 for polysaccharides. The corresponding RMSE values were 0.37, 0.04, and 0.86; RPD values reached 7.30, 10.97, and 11.16; while MAE values were 0.14, 0.02, and 0.38, respectively. These results demonstrate that integrating multivariate features extracted through diverse methods with 1D-CNN enables efficient prediction of AMM bioactive compounds using HSI. Full article

Continuum robots have garnered significant attention for their high flexibility and adaptability to complex environments. However, achieving the same level of high-precision control as rigid robots remains a significant challenge. This paper introduces an innovative Multi-Segment Extendable Soft Manipulator (MSESM) that employs a pneumatic–tendon hybrid drive mechanism. The design, utilizing off-the-shelf industrial bellows and 3D-printed components, allows the manipulator to achieve an extension ratio of up to 156.85%. By adopting a differential stiffness design, its bending stiffness was increased by approximately 4–5 times, its axial stiffness was increased by approximately 10 times, and its torsional resistance was enhanced, preventing inter-segment coupling during motion. At the control level, this paper proposes a hybrid control method that integrates a Constant Curvature (CC) physical prior with a data-driven neural network. Experimental results show that in tracking rectangular, triangular, and circular trajectories, this hybrid method reduced the average tracking error by 60.43% compared to a purely neural network-based controller, with the error reduction for the rectangular trajectory reaching 74.19%. This research validates a practical and effective approach for creating soft manipulators that successfully merge high flexibility with high-precision control. Full article

Ascites and renal dysfunction are among the most frequent and severe complications of decompensated advanced chronic liver disease (dACLD), often representing two interrelated manifestations of a shared pathophysiological continuum. Recurrent ascites and refractory ascites pose significant therapeutic challenges and are frequently associated with kidney impairment, particularly hepatorenal syndrome. Recent advances have reshaped the understanding of the underlying mechanisms, moving beyond the classical paradigm of peripheral arterial vasodilation to encompass systemic inflammation, gut dysbiosis, and cirrhosis-associated immune dysfunction (CAID). These insights have prompted a shift from uniform treatment protocols toward personalized, multidisciplinary strategies. Therapeutic innovations such as long-term albumin infusion, a transjugular intrahepatic portosystemic shunt, and the Alfapump^® system offer promising options, though each requires careful patient selection. Emerging approaches—including fecal microbiota transplantation and peritoneal dialysis—further expand the therapeutic landscape. Ultimately, early risk stratification, the integration of non-invasive tools, and individualized care models are essential to improving outcomes in this high-risk population. This review synthesizes current evidence and highlights future directions for the tailored management of dACLD patients with ascites and renal dysfunction. Full article

In order to achieve fast and accurate life damage online monitoring of the steam turbine rotor, it was significant to propose an empirical-statistical model using a machine learning algorithm instead of finite element simulation to improve the effect of operation. The finite element method was used to calculate the maximum stress during the start-up schedule. The linear CDM (Continuum Damage Mechanics) and nonlinear CDM were applied to assess the creep-fatigue damage of the steam turbine rotor. A empirical-statistical model of a 600 MW steam turbine rotor was established by using temperature change rate and maximum stress according to the finite element result samples, which is proposed by compared R2 of SVR (Support Vector Regression), LSTM (Long Short-Term Memory) and RRM (Ridge Regression Method), which was also verified by finite element simulation under a random start-up parameters. The results showed that the creep-fatigue damage could be calculated by nonlinear CDM for more safety rather than linear CDM. The R2 of SVR (Support Vector Regression), LSTM (Long Short-Term Memory) and RRM were 0.9377, 0.9647 and 0.999, respectively. RRM was more suitable for the empirical-statistical model establishment of the steam turbine rotor. By comparing the empirical-statistical model result and finite element result under random parameters of the start-up schedule, the error is 0.51%. Full article

Continuum robots with outstanding compliance, dexterity, and lean bodies are successfully applied in medicine, aerospace engineering, the nuclear industry, rescue operations, construction, service, and manipulation. However, the inherent low stiffness characteristics of continuum bodies make it challenging to develop ultra-long and small-diameter continuum robots. To address this size–scale challenge of continuum robots, we developed an 8 m long continuum robot with a diameter of 23 mm by a tip actuation and growth mechanism. Meanwhile, we also realized the untethered design of the continuum robot, which greatly increased its usable space range, portability, and mobility. Demonstration experiments prove that the developed growing continuum robot has good flexibility and manipulability, as well as the ability to cross obstacles and search for targets. Its continuum body can transport liquids over long distances, providing water, medicine, and other rescue items for trapped individuals. The functionality of an untethered growing continuum robot (UGCR) can be expanded by installing multiple tools, such as a grasping tool at its tip to pick up objects in deep wells, pits, and other scenarios. In addition, we established a static model to predict the deformation of UGCR, and the prediction error of its tip position was within 2.6% of its length. We verified the motion performance of the continuum robot through a series of tests involving workspace, disturbance resistance, collision with obstacles, and load performance, thus proving its good anti-interference ability and collision stability. The main contribution of this work is to provide a technical reference for the development of ultra-long continuum robots based on the tip actuation and steering principle. Full article

Background: Abiogenesis is hypothesized to have occurred in the aquatic environments of the early Earth approximately 3.8–4.0 billion years ago, in oceans containing high concentrations of ions (Na⁺ ≈ 470 mmol/L, Cl⁻ ≈ 545 mmol/L, Mg²⁺ ≈ 51–53 mmol/L, Ca²⁺ ≈ 10 mmol/L, K⁺ ≈ 10 mmol/L, SO₄²⁻ ≈ 28–54 mmol/L, HCO₃⁻ ≈ 2.3 mmol/L). Primitive membranes evolved ion-regulatory mechanisms to sustain electrochemical gradients, enabling metabolic activity. Objectives: This review compares the composition of amniotic fluid (AF) to seawater, framing AF as a “biological ocean” for the fetus, and evaluates the impact of micro- and nanoplastics (MNPs) on this protected milieu. Methods: We synthesized data from published studies on concentrations of and ions and other important substances in AF during pregnancy and compared them with marine values. Reports of MNPs detected in placenta, AF, and human organs were systematically reviewed. Results: AF exhibits high ionic similarity to seawater, although the absolute concentrations of ions are lower, reflecting evolutionary conservation. Recent analytical studies identified MNPs in samples of human placenta (4–10 particles per 1 g of tissue), meconium (median 3–5 particles per g), and AF (detectable in >60% of tested samples). Co-exposure to heavy metals, persistent organic pollutants, and endocrine disruptors were reported in 20–40% of maternal–fetal samples. Conclusions: The analogy between oceans and AF underscores a conserved evolutionary continuum. However, the infiltration of MNPs into intrauterine environments is a novel toxicological challenge with potential implications for neurodevelopment, immune programming, and epigenetic regulation. Within the One Health framework, protecting AF from anthropogenic contaminants is as critical as safeguarding marine ecosystems. Full article